Dexamethasone as adjuvant for Pre emptive Transversus Abdominis Muscle Plane Block in Patients Undergoing Bariatric Surgery

Background: A local anaesthetic (LA) solution is injected into the internal oblique and transversus abdominis muscles of the face during a localized analgesic technique called a transversus-abdominus muscle plane (TAP) block. This technique successfully inhibits the sensory nerves of the front abdominal wall, providing significant postoperative parietal pain relief. Laparoscopic bariatric procedures, while minimally invasive, can still result in considerable pain that may hinder early mobilization and recovery. Adjuvants like dexamethasone (DXM) are commonly used to prolong the duration of peripheral nerve blocks. Objective: This study aimed to evaluate the efficacy of adding of DXM for TAP in management of postoperative pain in laparoscopic bariatric procedures. Methods: This is a prospective controlled study enrolled 40 adult patients (aged 20 to 65 years). Scheduled for laparoscopic bariatric surgery. Participants were randomly allocated in two equal groups: Group D (dexamethasone) included 20 patients received bilateral ultrasound-guided (USG)-TAP block with total of 40 ml of 0.375% levobupivacaine plus 8 ml DXM and C (Control) group involved 20 patients subjected to bilateral (USG-TAP) by 40 ml 0.375% levobupivacaine only. Results: There was a significant difference regarding VAS scores between groups D and control C at movement and on rest. Patient satisfaction score in group D was higher than in group C. Patients in group D demonstrated early discharging time, also early time to ambulate, early intestinal activity regain and there was reduction of incidence of postoperative nausea and vomiting (PONV) in comparison with control group. Conclusion: The addition of dexamethasone to USG-TAP is a practicable and can be used with others different modes of analgesia in obese patients undergoing gastric sleeves operations.